Eating Disorders are very complex illnesses that affect all aspects of a person’s life. For ‘Part 1’ of this series, I am going to focus on some of the misconceptions and myths about eating disorders that inform the “9 Truths about Eating Disorders,” which is a PSA developed by several major eating disorder researchers, foundations, and treatment centers.
I am not going to address them all, but here is another article about those myths if you want to read more.
If you have an eating disorder, you look really sick (horrible/skinny/like a cancer patient).
Reality: for most people with eating disorders, you cannot tell a thing is wrong with them. We have a picture in our heads (depending on your generation, that might be Karen Carpenter, Jane Fonda, Princess Di, Demi Lovato, Zayn Malik, or one of the dozens of other celebrities who have come out to discuss their eating disorders) of what that looks like, and we do not usually stop to think about it.
These pictures are not representative of all people suffering with an eating disorder. I bet most of you know someone close to you that is struggling with an eating disorder right now – at least 50% of us do. Eating disorders have a lifetime prevalence rate of about 6.37%, or 21,084,700 people in the United States. There has been a 50% increase in hospitalizations due to eating disorders since 2019 – and that is taking into account that 70% of people with eating disorders will never get treatment specific to their disorder, most of those not seeking treatment at all.
Eating disorders are so stigmatized, even more so than other mental health disorders like depression and anxiety. They are secretive by their nature, hidden, and you might not know about any of it – unless you ask. A lot of people with DSM-V criteria based clinical eating disorders do not think they are “sick enough” to need treatment. They think that you have to be near death to ‘deserve’ treatment. That is so frustrating to me as a clinician – if people got help sooner and were more open to treatment, so much time, pain, energy, and effort could be saved!
Truth #1: Many People with eating disorders look healthy, but may be extremely ill.
Moms are to blame when their child has an eating disorder, they must have done something wrong/abused their child/have issues themselves.
There was a belief, for a long time (like from the late 1600s to the 1980’s; here is some more about the history of eating disorders) that parents, most often mothers, were to blame. In the early 1900s, girls with eating disorders were treated by taking them away from their parents and their homes. In the 1980’s, most books stated that mother’s neurosis caused the eating disorder.
While there is no doubt that modeling is the single biggest predictor of your child’s future behavior, and we may unintentionally teach eating disorder thoughts or behaviors, it is much more complicated than that. Our genetics, our society and culture, our peers, and other environmental factors are also causes.
The thing to focus on, though, is that we need social support, most often family support, to successfully overcome eating disorders. We all need support. Recovery is hard, and our families are the ones who most often step up and help.
Truth #2: Families are not to blame, and can be the patients’ and providers’ best allies in treatment.
Is it really that big a deal? It seems like everyone has an eating disorder these days.
There is a divide between disordered eating and an eating disorder. Yes, it is a continuum. Yes, there are a lot of people out there, more than we know, who have an eating disorder. And yes, they are ‘that big a deal.’
Not just because they have the highest mortality rate and tons of potential medical complications.
It is also a big deal because that statement invalidates someone’s suffering and invalidates their experiences. It stigmatizes them, and makes the entire world more ignorant (as all stigma does). Mental health matters!
Truth #3: An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.
Just eat! It’s not that hard.
Really? You seriously think that recovery from an eating disorder is ‘not that hard?’ Then clearly, you have not experienced it or had a loved one deal with it – or you have not supported them while they did. Just because something is easy for you, because you eat every day without thought, does not make it easy for everyone.
Some people think this about addictions, too. It is a widely held belief that these people (those with addictions or eating disorders or any other mental health issues) are ‘weak.’
To them, I say
Strength can not be measured until it is tested
If your strength (or conviction or knowledge or courage or fear) has not been tested in the same way, could we all try not assuming what others’ experience is like or that we know where the other person is coming from? Compassion is the best tool we have, not ignorance, intimidation, or derision.
Again, eating disorders are very complicated. They are not about appearance, food, control, attention, trauma, weakness, or any one thing. Making something black and white like that is judgmental. No one wants that to be applied to them. Attempting to paint millions of people and their individual experience with the same brush is not engaging your critical thinking skills at all. Come on!
Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.
Eating disorders are something that happen to white girls from the suburbs.
First, they don’t ‘just happen’ – again, it is a very complex set of biological, cultural, and environmental factors that create these disorders (as well as depression, anxiety, OCD, bipolar).
Second, having different cultural norms does not have anything to do with if something is a disorder or not – if you are black, Latinx, white, gay, transgender, straight, rich, poor, college educated or not, American or Asian, no matter what language you speak or what politics or religion you subscribe to, you are just as likely to have an eating disorder as anyone else.
Part of what the Diagnostic and Statistical Manual (DSM-V) and the International Classification of Diseases (ICD) try to do is standardize these diagnoses. Are they perfect? Of course not, but it is an attempt to quantify a complex set of illnesses, so there are a lot of factors. This is the tool we have.
Third, they happen to everyone. They do not discriminate. People from all walks of life and experiences have eating disorders.
It is this kind of thinking that keeps people from seeking treatment, and that hurts so many people in so many ways.
The population with the largest increase in eating disorder diagnoses are middle aged women – their rates of hospitalization increased 88% in ten years. In the same period of time, hospitalizations for men with eating disorders increased 53%. BED is more common than breast cancer, HIV, and schizophrenia. Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging. These are just a couple bits of information and statistics; if you want more try NEDA’s Research and Statistics Page.
Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.
Stay tuned for Myths about Eating Disorders, part 2!
If you are interested in working with an experienced eating disorder therapist, please contact me at firstname.lastname@example.org or call 757-734-1300. I am also a CEDS-S for those interested in iaedp certification!
Here are some other thoughts about Creating an Anti-Diet Culture and accessing sliding scale and pro-bono services through Project HEAL.